Deep brain stimulation for aggressiveness: long-term follow-up and tractography study of the stimulated brain areas

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OBJECTIVE

Initial studies applying deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) to patients with pathological aggressiveness have yielded encouraging results. However, the anatomical structures involved in its therapeutic effect have not been precisely identified. The authors’ objective was to describe the long-term outcome in their 7-patient series, and the tractography analysis of the volumes of tissue activated in 2 of the responders.

METHODS

This was a retrospective study of 7 subjects with pathological aggressiveness. The findings on MRI with diffusion tensor imaging (DTI) in 2 of the responders were analyzed. The authors generated volumes of tissue activated according to the parameters used, and selected those volumes as regions of interest to delineate the tracts affected by stimulation.

RESULTS

The series consisted of 5 men and 2 women. Of the 7 patients, 5 significantly improved with stimulation. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be involved in the stimulation field.

CONCLUSIONS

In this series, 5 of 7 medication-resistant patients with severe aggressiveness who were treated with bilateral PMH DBS showed a significant long-lasting improvement. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be in the stimulation field and might be responsible for the therapeutic effect of DBS.

ABBREVIATIONS DBS = deep brain stimulation; DLF = dorsal longitudinal fasciculus; DTI = diffusion tensor imaging; EEG = electroencephalography; FOV = field of view; ICAP = Inventory for Client and Agency Planning; MCP = midcommissural point; MFB = medial forebrain bundle; OCD = obsessive-compulsive disorder; PMH = posteromedial hypothalamus; VEEG = video EEG; VTa = ventral tegmental area.
Article Information

Contributor Notes

Correspondence Cristina V. Torres: University Hospital La Princesa, Madrid, Spain. cristinatorresdiaz@yahoo.es.INCLUDE WHEN CITING Published online February 7, 2020; DOI: 10.3171/2019.11.JNS192608.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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